- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $901.94 / $3,620.00 / $12,040.00
| Facility | | $901.94 | $3,620.00 | $12,040.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,736.22 / $4,819.47 / $9,980.98
| Facility | | $2,736.22 | $4,819.47 | $9,980.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.21 / $675.21 / $697.79
| Facility | | $675.21 | $675.21 | $697.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,823.38 / $2,418.96 / $6,644.00
| Facility | | $1,823.38 | $2,418.96 | $6,644.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,558.29 / $13,152.00 / $26,542.00
| Facility | | $9,558.29 | $13,152.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.73 / $864.95 / $1,499.05
| Facility | | $691.73 | $864.95 | $1,499.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.73 / $878.25 / $1,639.96
| Facility | | $691.73 | $878.25 | $1,639.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,200.00 / $10,600.00
| Facility | | $1,634.00 | $4,200.00 | $10,600.00 |